# KENDON A ROSS, DDS, MALIA FREDRICKSON, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558432146
- **Authorized official:** KENDON A ROSS DDS (OFFICER)
- **Authorized official phone:** (864) 882-0620

## Contact information

- **Practice address:** 10229 CLEMSON BLVD \# A, SENECA, SC 29678-0817
- **Practice address phone:** (864) 882-0620
- **Mailing address:** PO BOX 1897, SENECA, SC 29679-1897
- **Mailing address phone:** (864) 882-0620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3260 | SC | Yes |
| 1223G0001X | General Practice Dentistry | 3286 | SC | — |

## Other

- **Enumeration date:** 11/13/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9819 | — | SC |